Provider First Line Business Practice Location Address:
1702 N 52ND ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19131-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-878-1200
Provider Business Practice Location Address Fax Number:
215-878-1221
Provider Enumeration Date:
04/03/2012